FINAL ORDER

Jan Mills

Facilities Intake Unit (Electronic Mail)

Finance & Accounting Revenue Management Unit (Electronic Mail)

Lourdes A. Naranjo, Senior Attorney Office of the General Counsel

Agency for Health Care Administration (Electronic Mail)

Thomas W. Caufman, Esq.

Quintairos, Prieto, Wood & Boyer, P.A. 4905 West Laurel Street

Tampa, Florida 33607

(U.S. Mail)

Edward T. Bauer Administrative Law Judge

Division of Administrative Hearings

(Electronic Mail)

STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CUA IDENTIFICATION NUMBER:

AL11953616

(X2) MULTIPLE CONSTRUCTION

1. BUILDING:                       _

   
   

2. WING                                                   

(X3) DATE SURVEY COMPLETED

05/16/2013

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

FIVE STAR PREMIER RESIDENCES OF HOLLY 2480 NORTH PARK ROAD

HOLLYWOOD, FL 33021

(X4)ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION)

ID PREFIX TAG

PROVIDER'S PLAN OF CORRECTION (EACH CORRECTIVE ACTION SHOULD BE

CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY)

(X5) COMPLETE DATE

A ooo

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Initial Comments

Surveyor: 28825

An Assisted Living Facility Complaint inspection survey CCR# 2013002354 was conducted on 05/16/2013. The Five Star Premier Residences of Hollywood Assisted Living Facility had no deficiencies found at the time of the visit related to this allegation. Deficient practice was identified at the time of the survey unrelated to the complaint.

58A-5.023(3) FAC Physical Plant - Safe Living Environ/Other

1. OTHER REQUIREMENTS.

   1. All facilities must:

1. Provide a safe living environment pursuant to Section 429.28(1)(a), F.S.; and

2. Must be maintained free of hazards; and

3. Must ensure that all existing architectural, mechanical, electrical and structural systems and appurtenances are maintained in good working order.

(b) Pursuant to Section 429.27, F.S., residents

shall be given the option of using their own belongings as space permits. When the facility supplies the furnishings, each resident bedroom or sleeping area must have at least the following furnishings:

1. A clean, comfortable bed with a mattress no

   less than 36 inches wide and 72 inches long, with the top surface of the mattress a comfortable height to ensure easy access by the resident;

2. A closet or wardrobe space for hanging clothes;

3. A dresser, chest or other furniture designed for

   storage of personal effects;

4. A table, bedside lamp or floor lamp, and waste basket; and

5. A comfortable chair, if requested.

ADDO

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STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CUA IDENTIFICATION NUMBER:

AL11953616

(X2) MULTIPLE CONSTRUCTION

A BUILDING:                       _

B. WING                                                   

(X3) DATE SURVEY COMPLETED

05/16/2013

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

FIVE STAR PREMIER RESIDENCES OF HOLLY 2480 NORTH PARK ROAD

HOLLYWOOD, FL 33021

(X4)ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION)

ID PREFIX TAG

PROVIDER'S PLAN OF CORRECTION (EACH CORRECTIVE ACTION SHOULD BE

CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY)

(XS) COMPLETE DATE

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Continued From page 1

1. The facility must maintain master or duplicate keys to resident bedrooms to be used in the event of an emergency.

2. Residents who use portable bedside commodes must be provided with privacy during use.

3. Facilities must make available linens and

personal laundry services for residents who require such services. Linens provided by a facility shall be free of tears, stains and not be threadbare.

This Statute or Rule is not met as evidenced by: Surveyor: 28825

Based on observation, interview and record review, the facility failed to provide a safe environment, free from hazards. As evidenced by facility failure to prevent resident access to construction areas on the facility grounds.

The findings include:

During a tour of the facility on 5/16/2013 at approximately 12:00 PM with the Administrator and Corporate Attorney, residents were observed ambulating with rolling walkers throughout the facility and going outside to the front of the building. The complex was undergoing renovation. Multiple buildings were covered with scaffolding engulfing them completely. The demolition construction on the buildings was very loud and construction vehicles were coming and going throughout the facility parking lots and the facility entrance. Construction debris was noted in

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STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CUA IDENTIFICATION NUMBER:

AL11953616

(X2) MULTIPLE CONSTRUCTION

1. BUILDING:                       _

   
   

2. WING                                                   

(X3) DATE SURVEY COMPLETED

05/16/2013

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

FIVE STAR PREMIER RESIDENCES OF HOLLY 2480 NORTH PARK ROAD

HOLLYWOOD, FL 33021

(X4)ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION)

ID PREFIX TAG

PROVIDER'S PLAN OF CORRECTION (EACH CORRECTIVE ACTION SHOULD BE

CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY)

(X5) COMPLETE DATE

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Continued From page 2 the parking lots.

During the tour inside the facility, the main resident elevators were observed. During an interview with the Administrator at 12:40 PM on 05/16/13, she stated the facility had put up an enclosure fence for safety, which prevents resident access to the lakes edge. She stated that due to the renovation construction, the benches along the sidewalk had been removed. The surveyor observed scaffolding on the entire building next to the lake enclosed area. A white metal fence was observed to enclose the lake walkway and building frontage. Key pad access was noted on the outside entrance gates coming into/out of this gated area. The Administrator stated that the residents would need to know the pass code to enter or leave this enclosed area when outside the building. She stated that due to the renovation, residents should not have access to the construction area due to safety concerns.

On 5/16/2013 at approximately 3:30 PM the surveyor observed that a section of the metal fence enclosure around the lake walkway, (next to the front parking lot) was missing. The keypad and gate remained intact but the lake area had open access due to the missing fence section.

An interview was conducted with the Administrator and Executive Director on 05/16/13 at 3:40 PM, inquiring about the enclosed lake front area. They stated the fenced enclosure provided safety for the residents. The Administrator, Executive Director, Regional Director of Operations and surveyor observed the section of the fence that had been removed. The Executive Director stated she was not aware that the fencing had been removed and immediately went to speak with the construction foreman. She stated that the area was a construction site and

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STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CUA IDENTIFICATION NUMBER:

AL11953616

(X2) MULTIPLE CONSTRUCTION

A BUILDING:                      _

B. WING                                                       

(X3) DATE SURVEY COMPLETED

05/16/2013

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

FIVE STAR PREMIER RESIDENCES OF HOLLY 2480 NORTH PARK ROAD

HOLLYWOOD, FL 33021

(X4)1D PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION)

ID PREFIX TAG

PROVIDER'S PLAN OF CORRECTION (EACH CORRECTIVE ACTION SHOULD BE

CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY)

(XS) COMPLETE DATE

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Continued From page 3

should be closed off to prevent injury. The ground surrounding the open section of fence, was observed to be uneven, rocks and construction debris littered the pathway. Due to the fence removal, the enclosure did not provide protection for the vulnerable elderly residents since access could be achieved to both the lakes edge and construction site.

Class Ill

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